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Atypical Measles


Presentation

  • He presented with fever, shortness of breath and a purpuric rash. Radiological investigations allowed the diagnosis of severe nodular pneumonia.[ncbi.nlm.nih.gov]
  • Case Presentation: A healthy 54-year-old Asian female presented with 7 days of fever accompanied by a rash that spread from her neck and face to the entire trunk and extremities for the past 5 days.[shmabstracts.com]
  • This was a case of adult onset of atypical measles presenting with various symptoms, in which BALF was a useful diagnostic procedure.[jstage.jst.go.jp]
  • The new live vaccine doesn't have this atypical presentation, at least in the way the old killed vaccine did.[whale.to]
Fever
  • The most common admitting diagnoses were varicella, scarlet fever, meningococcemia, and Rocky Mountain spotted fever, due largely to the protean cutaneous manifestations. Roentgenographic studies showed diffuse, segmental, and nodular chest lesions.[ncbi.nlm.nih.gov]
  • Pneumonia is common … Medical dictionary AMS (atypical measles syndrome) — An altered expression of measles, AMS begins suddenly with high fever, headache, cough, and abdominal pain.[medicine.academic.ru]
  • It was characterized by a two- to three-day prodrome of high fever, cough, headache, and myalgia followed by a rash that resembled Rocky Mountain spotted fever, scarlet fever, or varicella and associated with roentgenographic evidence of pneumonia with[ncbi.nlm.nih.gov]
  • He presented with fever, shortness of breath and a purpuric rash. Radiological investigations allowed the diagnosis of severe nodular pneumonia.[ncbi.nlm.nih.gov]
  • Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain.[ncbi.nlm.nih.gov]
Malaise
  • Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain.[ncbi.nlm.nih.gov]
  • Three patients, referred to as having severe systemic reactions by Krause et al, 2 experienced fever to 103 F (39.4 C), malaise, marked local pain, swelling and erythema seven days following vaccination; these reactions lasted an average of eight days[pedsinreview.aappublications.org]
  • Prodromal period:  3-4 days  Non-specific symptoms: fever, malaise, anorexia, headache  Classical triad: cough, coryza, conjunctivitis (with photophobia, lacrimation) 8.[slideshare.net]
  • Initial temperature is usually high, Koplik spots and malaise are absent, and defervescence and rash occur simultaneously. Mortality is about 2/1000 in the US but is much higher in the developing world.[merckmanuals.com]
Edema of the Hand
  • Swelling (edema) of the hands and feet may occur.[medicine.academic.ru]
  • Swelling ( edema ) of the hands and feet may occur. Pneumonia is common and may persist for 3 months or more. AMS occurs in persons who were incompletely immunized against measle.[medicinenet.com]
Localized Pain
  • Three patients, referred to as having severe systemic reactions by Krause et al, 2 experienced fever to 103 F (39.4 C), malaise, marked local pain, swelling and erythema seven days following vaccination; these reactions lasted an average of eight days[pedsinreview.aappublications.org]
Pleuritic Pain
  • Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain.[ncbi.nlm.nih.gov]
Rales
  • Her respiration was normal and she had no rale. Her liver was palpable 1 cm below the 12th costal margin. The rash was maculopapular, erythematousand non-pruritic.[jstage.jst.go.jp]
Cardiomegaly
  • A chest roentgenogram disclosed cardiomegaly and small nodular shadows throughout the chest. Non-specific ST segment changes were noted on an electrocardiogram.[jstage.jst.go.jp]
Exanthema
  • Discussion: Measles is a highly contagious viral infection that is characterized by fever, coryza, cough, and exanthema. It is effectively preventable with MMR (measles, mumps, and rubella) vaccine.[shmabstracts.com]
  • The exanthema appeared 4 days after the development of fever and existed for 6 days. The similar exanthema as that of case 1 appeared on the back of fingers, hands, feet, earlobes, and the trunk, and small hemorragic exanthema on the hard palate.[webview.isho.jp]
  • Drug-induced exanthema. Onset is usually within 7 to 14 days of initiation of a course of oral medication. Figure 13.[jucm.com]
Phenylketonuria
  • * シソーラス PubMed, Scholar, Google, WikiPedia (葉酸補酵素系の欠乏による神経障害性疾患) 異型高フェニルアラニン血症 【類義語】 classical phenylketonuria, phenylketonuria atypical pneumonia ** コーパス PubMed, Scholar, Google, WikiPedia (細菌以外の微生物による肺炎の総称) 非定型肺炎 J189, 異型肺炎 atypical protein kinase[lsd-project.jp]

Workup

  • Complicated and possibly hazardous workups can be avoided by awareness of this disease.[ncbi.nlm.nih.gov]
Multiple Pulmonary Nodules
  • Pediatrics 50:712 PubMed Google Scholar Chun PKC (1978) Multiple pulmonary nodules in a young man. Chest 73:527–528 PubMed CrossRef Google Scholar Carlo J De jr, Startzman HH jr (1954) The roentgen study of the chest in measles.[link.springer.com]

Treatment

  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • Treatment Unfortunately, there is no cure for measles.[verywell.com]
  • […] and Therapy Treatment is supportive, focusing on relieving common symptoms and providing nutritional support, including vitamin A supplementation.[jucm.com]
  • Treatment is mainly supportive, but children should also receive vitamin A supplementation.[merckmanuals.com]
  • Reverse transcription-polymerase chain reaction testing can also detect measles virus in the blood and urine when direct evidence of the virus is necessary, such as in immunocompromised patients. 29 TREATMENT IS SUPPORTIVE Treatment of measles mainly[mdedge.com]

Etiology

  • The etiology of the measles infection in our vaccinated patient is not determined, yet the most plausible explanation is vaccine failure.[shmabstracts.com]
  • ETIOLOGY Measles virus An RNA virus of the genus Morbillivirus in the family of Paramyxoviridae One serotype, human’s only host Stable antigenicity Rapidly inactivated by heat and light Survival in low temperature. 4.[slideshare.net]
  • Cozen W, Hamilton AS, Zhao P, Salam MT, Deapen DM, et al. (2009) A protective role for early oral exposures in the etiology of young adult Hodgkin lymphoma. Blood 114: 4014-4020.[omicsonline.org]

Epidemiology

  • An earlier, landmark study in the American Journal of Epidemiolog y by the Center for Disease Control’s Roger Barkin found similar disturbing results of measles’ toll on the disadvantaged.[financialpost.com]
  • "Explosive School-based Measles Outbreak Intense Exposure May Have Resulted in High Risk, Even Among Revaccinees," Mikko Paunio (Department of Public Health, Helsinki University, published in the American Journal of Epidemiology,1998. 4.[vaclib.org]
  • EPIDEMIOLOGY Infection sources  Patients of acute stage and viral carriers of atypical measles Transmission  Highly contagious, approximately 90% of susceptible contacts acquire the disease.  Respiratory secretions: maximal dissemination of virus occurs[slideshare.net]
  • We are in the process of adding an epidemiological aspect to our studies. It is quite surprising that no additional laboratory did indulge in a similar research. Although the present study does not only look arduous, it is indeed![omicsonline.org]
Sex distribution
Age distribution

Prevention

  • Measles, a vaccine-preventable disease, is currently responsible for worldwide outbreaks mainly due to the failure to maintain high coverage of childhood immunisation.[ncbi.nlm.nih.gov]
  • Proper recognition of this syndrome will prevent unnecessary invasive diagnostic procedures.[ncbi.nlm.nih.gov]
  • Physicians should be aware of the atypical measles syndrome presentation in order to limit the delay of diagnosis, to avoid unnecessary investigations and to prevent the potential spread of this infectious disease.[casereports.bmj.com]
  • It is effectively preventable with MMR (measles, mumps, and rubella) vaccine. The etiology of the measles infection in our vaccinated patient is not determined, yet the most plausible explanation is vaccine failure.[shmabstracts.com]
  • Immunization with inactivated measles virus does not prevent measles virus infection. It can, however, sensitize a person so that the expression of the disease is altered, resulting in AMS.[medicinenet.com]

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